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High Court of Ireland Decisions |
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You are here: BAILII >> Databases >> High Court of Ireland Decisions >> Lehany v. Loftus [2001] IEHC 108 (20th July, 2001) URL: http://www.bailii.org/ie/cases/IEHC/2001/108.html Cite as: [2001] IEHC 108 |
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1. The
Applicant seeks the leave of this Court to institute Civil Proceedings as
against the Respondents arising out of his detention in the Department of
Psychiatry, County Hospital, Roscommon, on the 18th July, 1996 and thereafter.
2. The
Applicant has sworn an affidavit in which he deposes that on the 18th July he
was at home reading a newspaper when the first named Respondent, a medical
doctor who practices in Drumshambo, Co. Leitrim, called to his house. The
Applicant says that he knew the doctor and admitted him to his house. He
offered him a cup of tea. He said that the doctor sat down and told him that
he was not there on a courtesy call. He indicated that he had received a
telephone message from the Gardai stating that the Applicant was upset and that
they wanted a doctor to examine him. He states that the doctor told him that
he had himself been informed by the Gardai that the Applicant had threatened
his brother Ronan Lehany with physical violence during the course of an
argument on the 16th July, 1996.
3. The
Applicant states that the doctor, having indicated the nature of his visit,
asked him how he was feeling. The Applicant indicated to him that he felt fine
and when asked whether he was sleeping properly he replied that he was. The
doctor then stated that the Gardai had requested that the Applicant be taken to
Roscommon County Hospital for assessment. The Applicant states that he
indicated to the doctor at this stage that there was nothing wrong with him and
he replied to him that it was the Gardai who had directed this course of
action to be taken. He told the doctor that he was unsure as to how he was
expected to go to the Psychiatric Hospital and asked if he could go in a
private capacity. He has indicated that the reply given to him was, “I
don’t know. It’s up to yourself”. It appears that the
doctor then left his house. The Applicant says that the entire conversation
lasted less than 10 minutes and that there was no physical examination carried
out by the doctor and that the exchange of information was to the best of his
knowledge the only inquiries that the doctor made about his physical or mental
health. He says he was not asked about medication or whether he had been
feeling depressed or whether he felt violent or any question touching on those
matters. The Applicant states that as the doctor was leaving he said that he
would have to go to see the Applicant’s brother and his wife to see what
they had to say about it. The Applicant says that about an hour later he was
working in his hay shed when he heard the noise of a car outside. When he
stepped out of the building he saw a Garda squad car had arrived containing
three Gardai. He says that one of the members of the Garda Siochana produced a
piece of paper and said words to the effect, “Here’s a docket
signed by a doctor and you have to come with us”. He says that he asked
the Garda was it for an assessment to which the reply was given, “We
don’t know”. He says that he was allowed go into his house and
wash and change his clothes and that he was also permitted to talk to his
brother Seamus Lehany with whom he shares his home.
4. The
Applicant says that the Gardai showed him the letter which provided for his
detention and he accepted that he had no option but to go with them. He was
taken by the Gardai to Ballyfarnon Garda Station and later transported from the
station to the Psychiatric wing of Roscommon County Hospital by a local taxi
driver.
5. The
Applicant says that when he arrived at the hospital, which is controlled and
managed by the Western Health Board, he was seen by a Dr. Kelleghey who brought
him to a small reception room where they had a brief discussion. He states
that he was asked if he had any history of mental illness. He explained to the
doctor that he had suffered from a brief period of depression in or about 1985.
That had arisen following an accident at work where he suffered very severe
head and leg injuries. He was incapacitated for a period after this accident,
the consequence of which he became depressed. He was treated during this time
by Dr. Mary McGuire a Consultant Psychiatrist of Boyle, Co. Roscommon and was
placed on antidepressant medication for some time. As he became physically
rehabilitated his mental condition improved and since 1986 he has not been on
antidepressant medication and has not received any medical attention since that
time.
6. The
Applicant says that he was asked by Dr. Kelleghey about his family history and
he indicated to him that there was no history of mental illness in his family.
He was told by the doctor that he would be carrying out a number of tests which
he believes he passed satisfactorily. These involved reciting the days of the
week backwards and repeating an address in Galway to the doctor at various
intervals during his conversation. He says that he was very upset at being
brought to the Psychiatric Hospital but he co-operated at all times with the
authorities. He says that at the end of the consultation Dr. Kelleghey said,
“I can see nothing wrong and there is no need for medication”. He
said that the doctor said that he would not sign an Order for Detention until
he had been seen by Dr. Mary McGuire from Boyle. The Applicant says that it
subsequently transpired, however, that the doctor did sign a Detention Order as
soon as he arrived at the hospital. He was seen on the following morning by a
Dr. O’Shea who sent for Dr. McGuire. When Dr. McGuire saw him she said
words to the effect that “this is a nice slap in the face for you above
of all people”. She said that there was no need for him to be detained
in a Psychiatric Hospital and she quickly obtained two signatures to secure his
release. He left the hospital at approximately 2 p.m. on the 19th July, 1996.
The Applicant has exhibited a form under the Mental Treatment Act, providing
for the application, certificate and order for reception and detention of a
person as a temporary patient and as a chargeable patient in an approved
institution in pursuance of Section 184 of the Act. The application form is
signed by the Applicant’s brother Ronan Lehany and the Certificate of the
Registered Medical Practitioner is signed by Dr. Declan Loftus, the first
Respondent who certified on the 18th July, 1996 that he was of opinion that the
Applicant was suffering from a mental illness, required for his recovery not
more than 6 months suitable treatment and was unfit on account of his mental
state for treatment as a voluntary patient.
7. The
Applicant deposes his belief that Dr. Loftus in giving such a Certificate as a
Registered Medical Practitioner was not acting in good faith and the Applicant
believes he was negligent in the manner in which he gave that certificate. He
does not believe that the Certificate was warranted. His understanding is that
Dr. Loftus contacted the Gardai before he visited the Applicant’s home
and indicated to them that they ought to be prepared to bring a dangerous
patient, that is the Applicant, to Roscommon County Hospital. The Applicant
complains that Dr. Loftus acted on the basis of and placed too much emphasis on
a complaint by his brother Ronan Lehany. He had a serious disagreement with
his brother who alleges that he threatened him with a pitch fork. He says that
it is true that a heated verbal exchange occurred between them as a result of a
dispute but at no time did he threaten his brother with violence and in fact it
was he who issued threats to the Applicant. He says that he is unaware of any
complaint made to the Gardai about this and he has not been interviewed by the
Gardai concerning that incident.
8. The
Applicant does not believe that there were any justifiable grounds for the
Certificate issued by Dr. Loftus. As a result of his actions he was detained
for approximately one day in a Psychiatric Hospital in Roscommon and he was
considerably upset and embarrassed over the entire incident. This would not
have occurred had the first named Respondent exercised any reasonable care and
made proper inquires into his previous medical history. He believes that his
detention at the hospital was unwarranted and unlawful and he intends to issue
proceedings against the first and second named Respondents in relation to same.
He accordingly asks this Court for an order pursuant to Section 260 of the
Mental Treatment Act, giving him leave or liberty to institute civil
proceedings against the Respondents and each of them in respect of his
detention and for further or other relief.
9. An
affidavit has been sworn by Dr. Loftus in which he deposes to having known the
Plaintiff since he was a child both personally and as a patient. He treated
the Applicant in 1985 and in 1986 arising out of the accident referred to by
the Applicant. He was aware that the Plaintiff was being treated by a
Consultant Psychiatrist arising out of depressive symptoms at that time and
also for other related complaints. The doctor was aware from the report of Dr.
McGuire made in 1986 that she offered the view that any further stress on the
Applicant might induce a similar psychiatric illness to the one he was
suffering in 1985. He was also aware that the Applicant has seen Dr. McGuire
from time to time since 1986.
10. Dr.
Loftus sets out the background leading to the Applicant’s committal as
follows. Ronan Lehany who is also a patient, as is his wife and children,
informed the doctor approximately one month prior to the event complained of
that the Applicant was behaving quite strangely. Examples of the strange
behaviour alleged were that the Plaintiff was following him in his car and he
was also following Ronan Lehany’s children from school. He was also
informed that the Applicant had threatened Ronan Lehany verbally as a result of
a land dispute that was on going between them. He was informed by Ronan Lehany
and believed that he was genuinely fearful that an injury might he done to him
or his children. He advised Mr. Lehany to report these matters to the Gardai
and told him that if he saw the local Garda Sergeant he would advise him of
what Ronan Lehany had told him. Dr. Loftus states that about two weeks later
as he was travelling through Ballyfarnan he saw the Sergeant and he stopped and
told him what he had been told by Ronan Lehany. The Seargent indicated that he
would speak to the Applicant. On the 16th July, 1996 Ronan Lehany’s wife
called to his surgery at Drumshanbo. She stated to him that she was in fear of
Seán Lehany that he had attacked her with a pitch fork and only that her
brother-in-law Séamus was around at that time that she would have been
injured. She told the doctor that the Applicant had threatened to kill the
pups owned by her children and that her children were frightened and afraid to
go outside the house. The doctor advised Mrs. Lehany that she should report
these matters to the Gardai.
11. On
the 18th July, Ronan Lehany called to the doctors surgery and made further
complaints about the Applicant’s behaviour. He told him that he had
talked to the Gardai on the previous day and that the Gardai advised him that
he should seek a doctor in relation to the possibility of having the Plaintiff
committed. Ronan Lehany accordingly saw his locum Dr. McCarthy that day as he
(Dr. Loftus) was unavailable and Dr. McCarthy advised Ronan Lehany to speak to
Dr. Loftus when he came back on duty the next day as he was more familiar with
the patient. Following his conversation with Ronan Lehany on the 18th July he
told him that he would at his request call to see the Applicant. Prior to so
doing he telephoned the Gardai in Boyle as the Station in Ballyfarnan was not
operating that day. When the Gardai in Boyle informed him that they knew of
the Applicant, they indicated that they had interviewed the Applicant on
several occasions within the previous few weeks and felt that he was unwell.
12. Dr.
Loftus has agreed with certain aspects of the visit as deposed to by the
Applicant but denies that he told the Applicant who had requested him to visit
the Applicant. He says that he told the Applicant that he was there due to
reports he had received including the allegation that the Applicant has
attacked his sister-in-law and her children but did not specify the source of
that report. Dr. Loftus states that on hearing this the Applicant immediately
became agitated and aggressive, banged the table and jumped up and started to
pace up and down the floor. He repeatedly swore vengeance on his relations.
The Applicant was pacing up and down the floor apparently in a frenzy
repeatedly talking about his relations, his mother and their land. Dr. Loftus
states that these comments did not appear to be addressed to him directly. He
observed the Applicant who at this stage appeared to be in another world. He
formed the opinion that he was suffering from delusions. His eyes had a fixed
stare and he was frothing at the mouth. The Applicant then became a little
calmer at that stage and he (Dr. Loftus) suggested to the Applicant that he
should go to hospital for observation and assessment. When he suggested this
the Applicant again became very agitated. It was difficult to have a rational
conversation with him.
13. While
Dr. Loftus concedes that he asked the Applicant how he was sleeping and how his
appetite was, he denies that he informed the Applicant that the Gardai
requested that he be sent to hospital and he further denies that he asked him
to comment on whether there was anything wrong with him or not. At no time did
he inform the Applicant that the Gardai had directed that this course of action
be taken. He also denies that the Applicant said anything to him about going
in a private capacity to a Psychiatric Hospital or that he said to him that it
was up to himself. Dr. Loftus told the Applicant that if he did not go to
hospital on a voluntary basis he would be committed. At this stage he was
seated in the Applicant’s house and he came and stood over him in a
threatening manner and refused to go to hospital. He also threatened him by
saying that if he attempted to contact the Gardai he would get him. The
Applicant appeared to be in a type of frenzy and was not amenable to rational
conversation at this stage. The doctor then decided to leave as he was not
only upset by the Applicant’s behaviour but quite worried by his threat
which he felt he was well capable of carrying into effect.
14. While
Dr. Loftus agrees that he physically did not examine the Applicant at any time
as it would clearly not have been possible to physically examine him given his
agitated and aggressive state of mind but he did not feel at any stage that
such an examination was necessary or would have added to the view he had formed
of the Applicant’s medical condition. He felt he had asked the Applicant
relevant questions indicating psychiatric illness such as depression or
personality disorder. He was anxious not to ask the Applicant any questions
which he might perceive as being offensive and thereby possibly put his safety
at risk. He was quite satisfied from his discussion with the Applicant and
from his observation of him that he had more than ample opportunity of forming
a proper and considerate clinical assessment of his mental condition. He had
no doubt and still has no doubt that at the time the Applicant was mentally ill
and was potentially a danger to himself and to others. Dr. Loftus further
denies having said to the Applicant that he would have to go and see his
brother and his wife to see what they had to say about it or anything to the
like effect.
15. Dr.
Loftus says that it is true that he did sign the certificate exhibited by the
Applicant but in doing so he acted properly and in the best interests of both
the Applicant and members of the family. He refutes entirely the allegation
that he acted in bad faith or negligently in the manner in which he gave the
certificate. He denies that he informed the Gardai that they ought to be
prepared to bring a dangerous patient to Roscommon County Hospital or so
informed the Applicant as he alleges. When he telephoned the Gardai he
informed them that he was going to see Mr. Lehany who was reported unwell. He
asked them if they would be available to take the Applicant to Roscommon if he
so needed them. He only telephoned to ascertain their availability. Dr.
Loftus denies that he placed too much emphasis in signing the certificate on a
complaint made solely by the Applicant’s brother. In signing the
certificate he believes that he acted on the basis, firstly of his own clinical
assessment and judgment of the Applicants condition and secondly on the basis
of a credible history of the Applicant’s behaviour in recent past which
he considered to come from reliable witnesses and thirdly on the basis of the
Applicants medical and psychiatric history then known to him. He also believed
at all material times in addition to the foregoing matters that there was a
genuine and immediate risk to the safety, health and welfare of the Applicant
and the members of his family which as a minimum require urgent psychiatric
assessment and, if necessary, treatment. On this basis he refutes the
suggestion that there were no justifiable grounds for the issuing of the said
certificate and he remains firmly of the view that the same was entirely
justified and proper.
16. An
affidavit has been sworn by Dr. Mary McGuire who is a Consultant Psychiatrist
with the Respondent Health Board at the Department of Psychiatry at the County
Hospital in Roscommon. She has referred to documented notes which show that it
was alleged that the Applicant attacked his sister-in-law the previous day with
a pitch fork and threatened to kill the family dogs and poured hot water on his
brother. She says that the Applicant was interviewed by the admitting doctor,
Dr. Seamus O’Ceallaigh. The Applicant stated that he had been involved
in a dispute with his brother and wife since the death of his mother. He
stated that his mother had left all her land and property to him and that his
brother was aggrieved by this. The Applicant’s brother lives nearby.
The Applicant alleged that his brother had assaulted him in the past and had
called in the Gardai but that charges had not been pressed for the sake of the
family. Dr. McGuire indicates that the Applicant alleged that on the previous
day, the 17th July, 1996 his brother denied him access to his own lands and
alleged that his brother had stated that he would slit his throat. The
Applicant also alleged according to the notes that his brothers wife had
verbally abused him the previous day and had called him a homosexual and
allegedly stated that she had contacts in the USA and would have him killed.
In further reference to the notes, Dr. McGuire says that the Applicant felt on
admission that he had been signed into hospital in order to ruin him and to
weaken any testimony he might give.
17. Dr.
McGuire was aware of the mental state examination carried out on the 18th July,
1996 by Dr. O’Ceallaigh. This examination indicated that the mood of the
Applicant was reported to be objectively and subjectively depressed at the time
and that his affect was appropriate. He denied any obsession or compulsions
and denied de-personalisation/de-realisation. There was no evidence of
delusions and his thought was normal in form. The Applicant denied any
hallucinations. He was normally orientated. His attention and concentration
were normal and he had no problems with recent or remote memory.
18. As
part of the management plan drawn up in respect of the Applicant, Dr. Seamus
O’Ceallaigh contacted her by telephone. They discussed the case over the
telephone and discussed the possibility that the General Practitioner had been
supplied with false or misleading information or in the alternative that the
Applicant may be suffering from a problem with his mental state, which would
need to be more accurately assessed, particularly with a view to obtaining a
collateral history which could be obtained to establish what the real situation
was. With this in view it was decided between herself and Dr.
O’Ceallaigh to admit the Applicant overnight for observation. She says
that on the following morning the Applicant was interviewed at length. During
this time of interview he never displayed any psychotic symptoms and always
presented as calm, shy and quiet. He was always pleasant and co-operative.
Early on the morning of the 19th July the Applicant’s brother Seamus, who
resides with him, called to her home to state that the Applicant should not be
in hospital, that he was perfectly sane and reasonable and that he was the
victim of his brother’s bitterness over a land dispute. Mr. Seamus
Lehany wanted his brother, the Applicant discharged on that day. During her
interview with the Applicant on that day he had appeared calm, coherent and
rational. He was upset by his predicament and wanted to go home. He stated
that he did not know his rights when he was certified and would have availed of
a solicitor and would have had a second medical opinion had he been aware of
his rights before he was taken to hospital. He gave his word that he would not
contact his brother Ronan, his wife or children and that he would deal with any
difficulties through legal channels only. Dr. McGuire says that following this
interview another brother of the Applicant telephoned her from Dublin stating
that he was amazed and aghast at the Applicant’s predicament. He wanted
the Applicant discharged immediately. This brother subsequently faxed a note
supporting the Applicant’s request for discharge and outlining the
Applicant’s good character.
19. Dr.
McGuire then spoke with the referring General Practitioner, Dr. Declan Loftus
by telephone on the morning of the 19th July and Dr. Loftus stated that in his
opinion the Applicant had been agitated the previous day because of the dispute
and Dr. Loftus was worried in case a further row would erupt and the Applicant
would damage somebody. Dr. Loftus was seriously concerned that this was a real
and substantial danger. She says that at this stage it was appropriate that a
management plan be drawn up in respect of the care of the Applicant. Because
collateral statements had been given by two members of the Applicants family
and following psychiatric assessment of him and observation overnight it was
decided that he could be discharged from hospital and he was so discharged on
the 19th July, 1996. She has seen the Applicant on a number of subsequent
occasions and again he presents in a calm, coherent manner and he is on no
psychiatric medication. The Applicant was admitted as a certified patient on
the 18th July, 1996. It was felt prudent and appropriate that he be detained
overnight in order to further assess his mental state and, in particular, to
get a collateral history with regard to the family dispute. It was also
necessary to observe and assess the Applicant should he be suffering from any
behavioural or psychotic problems. On the following morning two members of the
Applicant’s family substantiated his claim that he was a victim of a land
dispute. This was the collateral history which was necessary to be obtained,
together with the observations taken of him to ensure that the Applicant was
not suffering from any more serious and substantial problems. Once the
observation of the Applicant was made and once the collateral history was taken
he was immediately discharged from the hospital and she believes that at all
times the Health Board acted in a good faith and with the best interests of the
Applicant in mind without any ulterior or other motives, other than his mental
health, his mental welfare, his own safety and the safety of members of his
family and no consideration other than those were taken into account in the
assessment, observation and treatment of the Applicant.
20. A
further affidavit of has been sworn by Dr. Seamus O’Ceallaigh who says
that he is a resident Medical Practitioner practising in the field of
Psychiatry. At the time of the Applicant’s detention he was employed by
the Western Health Board in the Western Psychiatry Rotation and was part of
that particular medical group. He was Senior House Officer at the Department
of Psychiatry, Roscommon County Hospital and an application for admission of
the Applicant as a temporary, chargeable patient had been made by Mr. Ronan
Lehany a brother of the Applicant. A certificate had been signed by the
General Practitioner Dr. Declan Loftus. Part of the temporary patient
(chargeable) form under the Mental Treatment Act of 1945 had been filled in by
Dr. Declan Loftus and signed by him dated the 18th July, 1996. In addition to
the form there was a referral letter from Dr. Declan Loftus indicating that
the Applicant had attacked his sister-in-law with a pitch fork on the 17th
July, 1996 and threatened to kill the family dogs and had thrown hot water over
his brother Ronan Lehany. He learned from the Applicant that he had previously
been treated by Dr. Mary McGuire, Consultant Psychiatrist but he did not have
access to any old case notes at the time he carried out his assessment. He
interviewed the Applicant when he presented at Roscommon County Hospital on the
18th July, 1996. He denied that the events reported by the General
Practitioner had taken place. The Applicant claimed that he had been involved
in a dispute with his brother, Ronan Lehany, and his brother’s wife since
the death of his mother. He informed Dr. O’Ceallaigh that his mother had
left all her land and property to him and he believed that his brother was
aggrieved by this. He alleged that his brother had assaulted him on several
occasions in the past and that he had reported these assaults to the Gardai but
had not pressed charges for the sake of the family.
21. The
applicant told Dr. O’Ceallaigh that on the day before assessment his
brother Ronan had denied him access to his own lands. He alleged that his
brother has threatened to slit his throat and that his brother’s wife had
verbally abused him and had called him a homosexual. He claimed that she had
told him that she had contacts in the United States who would have him killed.
The Applicant further stated that Dr. Declan Loftus had called his house on the
morning of the interview namely the 18th July, 1996 and asked the Applicant to
come to Roscommon County Hospital for an assessment. The Applicant agreed to
come to the hospital voluntarily but expressed concerns to him that he had been
signed into hospital by his brother. He believed his brother’s motive in
doing so was to attempt to discredit him and any testimony he would give in
future court proceedings arising out of alleged assaults on him by his brother
Ronan. Dr O’Ceallaigh took a detailed medical history from the Applicant
during the interview. He also took details of the Applicant’s family
history which showed that the Applicant’s father had had a history of
depression. The applicant denied any other family history of psychiatric
illness. He alleged that his brother Ronan has a history of violent behaviour
and had assaulted other brothers in addition to the Applicant.
22. Dr.
O’Ceallaigh also took a social history of the Applicant who indicated to
him that he was a shy, easy going person who engaged in few hobbies and that he
frequently felt depressed. There were no other independent reports of
pre-morbid personality available to him at the time of that interview. Dr.
O’Ceallaigh also asked the Applicant about his developmental history. As
a result of his interview with the Applicant he assessed him and assessed his
medical and mental state. The Applicant was tearful and upset and related this
to the perceived implications of being detained in a Psychiatric Hospital. The
Applicant was co-operative and pleasant during the interview and did not engage
in any threatening behaviour. His speech was coherent and relevant, he spoke
at a normal rate and, admitted to feeling depressed and objectively appeared to
be so. He denied having a death wish or any thoughts of harming himself. Dr.
O’Ceallaigh states that in his opinion the Applicant’s behaviour
was appropriate. He says that he denied obsessional thoughts and he could find
no evidence of these or of any compulsive behavioural phenomena. He did not
elicit any delusional beliefs and was unable to judge whether or not they were
present without a collateral history. The form of the Applicant’s
thought did not appear disturbed. The Applicant denied experiencing any
hallucinations. He was oriented to time, place and person. Attention,
concentration and memory appeared to be normal to informal clinical testing.
Dr. O’Ceallaigh also carried out a physical examination of the Applicant
at the time.
23. Dr.
O’Ceallaigh says that as the history related to him by the Applicant was
in conflict with that provided by Dr. Loftus in his referral note. He decided
it was important to contact Dr. Loftus to seek clarification and he did so.
He spoke to Dr. Loftus by telephone and Dr. Loftus confirmed the details of his
referral note and alleged that Mr. Lehany had made numerous complaints to the
Gardai in the past, claiming ill treatment at the hands of his brother Ronan.
Dr. Loftus also informed him that the Applicant had never admitted to psychotic
symptoms in the past. Dr. O’Ceallaigh says that at this point it was
important that he should make a differential diagnosis which he duly did.
Having considered the possibility that the Applicant had been the victim of a
misleading and inaccurate versions of events related to his General
Practitioner by his family members. He also considered the possibility that
the Applicant may have been suffering from a psychotic disorder which may have
impaired his judgment and placed his physical safety and that of his family at
risk. He assessed these as being two possibilities and then he decided to
telephone Dr. Mary McGuire to seek advice on how to further proceed. He
discussed the case with her and it was decided to admit the Applicant as a
temporary patient overnight. The purpose of this was to make observation of
his mental state overnight and to allow a collateral history to be obtained.
After a telephone conversation with Dr. McGuire he then signed the Detention
Section of the Temporary Patient Chargeable Form, pursuant to the Mental
Treatment Act, 1945 and did not prescribe medication for the Applicant but made
arrangements to examine him if observation of the Applicant’s unmedicated
mental state overnight revealed any significant abnormalities. He remained on
all night until 9 am on the 19th July and was not asked to see the Applicant
again.
24. He
further discussed the Applicant’s admission with Dr. O’ Shea to Dr
McGuire on the morning of the 19th July, 1996. The Applicant was interviewed
by Dr. McGuire on the morning of the 19th July, 1996 and was discharged at
around lunchtime on the same date. Having reached the differential diagnosis
which he did namely that the Applicant could be the victim of misleading
information having been given about him to his GP or, in the alternative, he
could have been suffering from a psychotic disorder, which may have impaired
his judgment and placed his own safety and that of his family at risk, these
were the possibilities which he believed existed at the time of the
Applicant’s admission to Roscommon County Hospital. With those two
possibilities in mind, he preceded further to consult Dr. McGuire and they
reached the conclusion that admitting the Applicant overnight for observation
was the best and most prudent course of action to take in all the
circumstances. He said that this course of action was taken in good faith with
the best interests of the Applicant in mind and was in all the circumstances
the appropriate medical response to the facts with which he was presented.
25. Based
upon this section it is submitted on behalf of the Applicant that he has
discharged the onus imposed upon him to satisfy the court that there are
substantial grounds for contending that the persons against whom the
proceedings are to be brought, namely the first and second Respondents acted in
bad faith, or in particular in the context of this case, without reasonable
care. It is submitted by counsel on behalf of the Applicant that the term bad
faith has to be seen in the legal sense rather than in moral sense of the word
and that in the instant case the Applicant has established what amounts to a
prima
facie
case. By reference to the decision of the Supreme Court in the case of
Bailey
-v- Gallagher [1996] 2 ILRM 433
it was submitted that the Applicant is not required to do more than satisfy the
Court on the balance of probabilities that substantial grounds exist. Under
the provisions of Section 184 sub-section 4 of the Mental Treatment Act, it is
provided
inter
alia
as follows
26. Counsel
asked rhetorically how could such a fundamental difference of opinion arise
within a matter of a few hours between the opinion formed by Dr. Loftus on the
one hand and the two psychiatrists at the hospital on the other hand. It was
submitted that Dr. Loftus erred in reaching the opinion to which he certified
and that he placed undue reliance upon what was told to him by the brother of
the Applicant. It is submitted that he made no independent investigation to
ascertain the veracity of the background dispute and that the Certificate in
the instant case therefore does not satisfy the requirements of Section 184
subsection 4. In this case the Applicant’s complaint is that he was
subjected to a holding exercise on foot of which he was detained overnight. It
is submitted that it is clear from the examination of the Applicant that was
carried out that he was not suffering from any mental illness and should have
been released. The Applicant was detained merely for investigation. It is
submitted that the holding for the purposes of an investigation is not
permissible under the provisions of the Act, that on the evidence he was normal
when seen at the hospital. There were no clinical findings and this was all
within a couple of hours of the initial certificate by Dr. Loftus. It is
submitted that the finding by Dr. O’Ceallaigh leads inexorably to the
inference that Dr. Loftus grossly misdiagnosed the Applicant and that this was
so wrong as to show that reasonable care had not been taken by him. The views
of the two doctors are at opposite ends of this spectrum.
27. On
behalf of the first Respondent Mr. Seamus Noonan of Counsel submitted in the
first instance that the Applicant’s brother is the villain of the peace
and that Dr. Loftus has been criticised for failing to verify the
brother’s account. He points to Dr. Loftus’s affidavit which until
1999 has not been controverted. It is submitted that this Court cannot resolve
conflicts on the evidence in favour of the Applicant. By reference to the
evidence it is submitted that the doctor knew the family in question and acted
on the basis that he believed that he had credible and reliable informants in
this case. He acted in the belief of a risk to the Applicant and others and in
circumstances where he says he was fearful of his own safety. This is something
that has not been disputed on the evidence before this Court. With regard to
the standard of proof to be established it is submitted that it is wrong to say
that there is only an obligation to establish a
prima
facie
case exists. It is submitted that an Applicant must go much further than this.
It is submitted that the Section is there to protect doctors and this arises in
circumstances where they may be dammed if they do certify and dammed if they
don’t on the other hand. It is submitted that the Court must have regard
to the difficult position that doctors find themselves in.
28. Counsel
referred this Court to a passage of the judgment of Griffin J in the case of
O’Dowd
-v- North Western Health Board [1982] ILRM 186
where at page 194 of the report Griffin J stated as follows:-
29. Counsel
further referred this Court to the quoted passages from the case of
Richardson
-v- London County Council
[1957] 1 WLR 751 referred to by Griffin J in the
O’Dowd
case quoting the judgment of Denning LJ and Parker LJ in that case. He
concluded in that case that he would adopt what was said by Denning LJ and
Parker LJ in respect of the corresponding section of the English Act which is
in similar terms to the Irish Act.
30. Counsel
further referred this Court to the authority of
Murphy
-v- Greene
[1991] ILRM 404 which dealt with the same section of the Mental Treatment Act
of 1945. In this particular case the doctor visited the Applicant who was in
custody in a Garda Station at the time. He appeared to be in an advanced state
of intoxication and was aggressive, disorientated and uncooperative. He
refused upon request to allow himself to be physically examined or to admit
himself voluntarily to a Psychiatric Hospital. The Defendant telephoned the
doctor on call service to check the facts of the Plaintiff’s medical
history. He then ascertained from St. Brendan’s Hospital that the
Plaintiff would be received there for assessment and signed a Certificate
pursuant to the 1945 Act certifying that in his opinion the Plaintiff was an
addict and required at least six months preventative and curative treatment.
The Plaintiff was then taken by Garda escort to the hospital but was discharged
the following day. The Plaintiff obtained permission from the High Court to
institute proceedings against the Defendant seeking damages for negligence,
false imprisonment and libel. The Defendant appealed the matter to the Supreme
Court where it was held by the Supreme Court in allowing the Appeal
32. In
the same case the Chief Justice indicated at the bottom of page 413 of the
report that the provisions of Section 260 (2) clearly permit and almost direct
the Court to have full regard to what is offered by a proposed defendant upon
the hearing of such an application. Further at page 414 of the Report he
indicated that a diagnosis which merely proves to be incorrect is not evidence
in itself of either want of good faith or want of reasonable care. In the same
case at page 415 of the report Griffin J indicated that he had previously
imposed a standard which was too high and indicated that, properly construed,
what is required by Section 260 is that an Applicant for leave to institute
proceedings must establish, as a matter of probability, that there are
substantial grounds for the contention that the proposed defendant acted in bad
faith or without reasonable care. At the end of page 416 of the report
O’ Flaherty J stated as follows:
33. In
the same case McCarthy J at page 418 of the Report dealt with the concept of
substantial grounds where he stated as follows
34. Dealing
with the particular facts of that case at page 420 of the Report McCarthy J
stated as follows:-
35. Further
on the same page McCarthy J dealing with the facts of the particular case
indicated that the fact that the Applicant was released following his admission
to hospital in his view added nothing to the case.
36. Counsel
has further referred this court to the decision of the Supreme Court in the
case of
Mary
O’Reilly -v- Moroney
(Unreported Supreme Court 16th November, 1993) where O’Flaherty J
concurred with the approach of Egan J in the relation to the question of an
examination. O’Flaherty J indicated that there is no doubt that Section
184 of the 1945 Act casts a very heavy responsibility on any doctor attempting
to operate it, dealing, as it does, with the liberty of the individual. In
that case the facts illustrated at page 7 of the judgment of Egan J indicate
that the doctor seeing the Applicant saw that she was in an extremely
disturbed mental state, very agitated, acutely anxious and very hysterical,
when her husband knocked at the door of her house. The doctor decided that
there was a probability or possibility at least of her being a danger to
herself that night. He decided not to try to interview her as it might
aggravate the situation. He stated that he had been told earlier in the
evening that she had threatened to assault her husband with a hay fork. He
made no effort, therefore, to interview her but went to the home of the mother
of the husband where he signed the certificate. At page 9 of his judgment Egan
J stated as follows:-
37. Mr.
Noonan submitted that it is clear from the authorities that the suggestion that
a
prima
facie
case is all that is required to be shown by an intending plaintiff is an
incorrect standard and furthermore that
Bailey
-v- Gallagher
does not reverse the decision of the Supreme Court in the case of
Murphy -v- Greene.
38. With
regard to the complaints of Dr. Loftus first of all that no physical
examination was carried out by him, counsel has pointed out by reference to the
authorities that none as such is required and further by reference to paragraph
6 of the Applicants affidavit that he was not asked about medication etc.
Counsel referred to the uncontradicted evidence of Dr. Loftus. With regard to
the suggestion that the doctor placed too much emphasis on the report from the
applicant’s brother, Dr. Loftus has indicated that he considered the
source of the brother to be a reliable and credible one at the time. Dr.
Loftus has also spoken to the Gardai at the time. It is further submitted that
there was no need for him to make any further enquiries insofar as Dr. Loftus
was the applicant’s own doctor. It is also clear he had the benefit of
Dr. McGuire’s report.
39. Counsel
had further referred this Court to the terms of the High Court proceedings
intended in this action and has submitted that such claim in any event is
statute barred. He referred to the fact that the motion in this case issued in
June 1999 and that the statute ran out at the end of July 1999. In this regard
Counsel referred me to the decision of Geoghegan J (unreported 2nd July, 1999)
in the case of
Blehein -v- Murphy & Ors
where at page 5 of his judgment Geoghegan J stated as follows:-
40. In
like vein in this case it is submitted by Counsel for the first Defendant that
the claim which is proposed to be brought in these proceedings is statute
barred and it is another basis upon which this Court should refuse the
Applicant the relief which he seeks to institute the intended proceedings in
question.
41. On
behalf of the second Respondent, the Health Board, Mr. Keane of Counsel adopted
the submissions made by Mr. Noonan on behalf of the first Respondent. Counsel
referred this Court to the decision of McGuinness J delivered the 19th June,
1997 in the case of
Melly -v- Moran and Anor
where at page 24 of her judgment she applied the test already referred to in
the course of this judgment that what she was required to do was to decide
whether there are substantial grounds for contending that either the first or
second named Defendant acted without reasonable care. In that case she
indicated that it was clear from the preponderance of the judgments of the
Supreme Courts that Section 260 is designed to prevent a vexatious or ill
founded actions against medical practitioners in the circumstances of mental
illness.
42. Counsel
referred this Court further to the decision of O’Higgins J in the case of
Kiernan
-v- Harris and Ors.
(unreported High Court 12th May, 1998) where at page 7 of his judgment he
indicated that on the evidence before him that the Practitioner was not acting
in good faith. He had indicated further that because he had failed to act with
reasonable care in all the circumstances he would allow the proceedings to be
instituted against the intended Defendant. With regard to the actions of the
Health Board in that case O’Higgins J said that it would be quite
unreasonable to demand that the Health Board should see to it that another
party carried out its legal obligations.
43. It
is submitted that by reference to the affidavit of Dr. O’Ceallaigh that
he exercised great care in discharging his functions on behalf of the Health
Board under the Act.
In
reply to the submissions of Counsel for the proposed Defendants, Mr. Clarke on
behalf of the Applicant referred to the fact that the medical report referred
to in the affidavit of Dr. Loftus is stated to have been dated the 15th May,
1986 while that produced bears the date of October 1986.
44. Counsel
further referred this Court to the dissenting judgment of Blayney J in the case
of
O’Reilly
-v- Moroney and the Mid Western Health Board
delivered the 16th November, 1993. In that case Blayney J referred to the
judgment of the Chief Justice in the
O’Dowd
case where O’Higgins CJ stated at page 190 of the Report:-
45. “
I am satisfied that the use of the phrase “substantial grounds” in
this context, notwithstanding the Constitutional interpretation which I have
indicated as being appropriate for the construction of this section, would mean
something more than probable or prima facie grounds”.
46. Based
upon the judgment of the then Chief Justice in the
O’Dowd
case, Mr. Clarke says that the appropriate standard of proof for the Applicant
in the instant case is to establish a
prima
facie
case.
47. Subsequent
to the oral hearing in this case, written submissions were furnished at the
invitation of the Court by the parties in regard to the issue of the statute of
limitations. On behalf of the first named Respondent it was pointed out that
in the Draft Plenary Summons exhibited in the grounding affidavit the Applicant
proposes to claim damages for personal injuries allegedly sustained by him as a
result of the negligence, breach of duty, breach of statutory duty and unlawful
detention of the Applicant by the Respondents. Section 11(2)(b) of the Statute
of Limitations 1957 provides that such an action shall not be brought after the
expiration of 3 years from the date on which the cause of action accrued. In
the present case the detention of which the Applicant complains, occurred on
the 18th July, 1996 and accordingly it is submitted that the action is statute
barred in circumstances where the Plenary Summons is not issued before the 18th
July, 1999. It is submitted by reference to Section 260 itself that the
institution of the proceedings can only occur after leave has been granted by
the High Court. It is submitted that the application for leave cannot
constitute the institution of proceedings for the purposes of the Statute of
Limitations. Section 259 of the Act of 1945 provided as follows;-
48. It
is submitted that given the very short limitation period involved and the
potential difficulty of having the matter determined by the Court within that
time frame the Oireachtas clearly considered it appropriate to enact the saving
provision in Section 260(4) which provided that the proceedings would be deemed
to have commenced on the date on which the Notice of Application for Leave was
given to the Respondent. However, Section 259 and Section 260(4) have now been
repealed. It is submitted accordingly that the ordinary limitation periods now
apply which the Oireachtas might well have considered to be sufficient for the
purposes of enabling an application to be brought and adjudicated upon before a
claim would become statute barred. On behalf of the first Respondent it is
submitted that there is no lacuna in the legislation which is perfectly clear
in its meaning and effect. It is submitted that insofar as the Applicant seeks
to argue that the cause of action in the present case does not accrue until
such time as the Court grants leave to institute proceedings, the logical
extension of this submission is that a claim by a potential Plaintiff who is
being detained under the provisions of Section 145 of the Act can never be
statute barred because the cause of action does not accrue until he is given
permission to institute proceedings be it 10, 20 years or longer after the
events giving rise to the claim. It is submitted that in that situation all a
prospective plaintiff has to do to avoid the Statute of Limitations is to issue
his writ within 3 years after having been given permission by the Court to do
so. It is submitted that this proposition is untenable.
49. In
support of his submission in this regard, Counsel has referred to portion of
the judgment of Geoghegan J in
Blehein
-v- Murphy and Ors.
(High Court, unreported 2nd July, 1999) already cited in this judgment.
50. On
behalf of the Applicant it is submitted that there is a lacuna in the
legislation with regard to what if any time limit applies to the issuing of
proceedings proposed by the Applicant herein. It is submitted that the
relevant period of limitation which under the statute of limitations would be
three years does not begin to run until the High Court has by order authorised
the institution of proceedings or within three years of such proceedings being
authorised by the Supreme Court on appeal from the High Court. It is submitted
that insofar as Section 260 of the Act of 1945 represents a legislative
restriction on a person’s constitutional right of access to the Courts
that any such statutory curtailment of the right of access to the Courts must
be strictly construed.
51. In
light of the Statute of Limitations of 1957 providing prima facie a three
limitation period it is submitted on behalf of the Applicant that the essential
element of having a “cause of action” is the right to immediately
issue Court proceedings. It is submitted that a cause of action cannot exist
where the person seeking to institute proceedings is prohibited by statute from
so doing. The cause of action can only be complete when the Applicant is given
permission to institute proceedings. It is submitted further that until
permission is given the proposed cause of action is incomplete or inchoate.
52. The
Applicant submits that it would be illogical and constitutionally unsound if,
on the one hand, time was running against him pursuant to the Statute of
Limitations 1957, while simultaneously he was prevented from issuing
proceedings by reason of the provisions of Section 260 of the Mental Treatment
Act, 1945. It is submitted that the illogicality in practical terms can be
illustrated by the sometimes slow pace of modern litigation and it is perfectly
possible that if a person were to issue a motion seeking liberty to bring
proceedings of the nature herein, within a week of being released from
detention in a Mental Hospital, it could well be in excess of three years
before a final appeal might be heard by the Supreme Court. Procedural steps
such as applications for Orders of Discovery, the possibility of Appeals to the
Supreme Court against Orders of Discovery, the awaiting of a listing in a list
to fix dates followed by an appeal to the Supreme Court on the substantive
issue, could easily take in excess of three years. It would be
unconstitutional for the Applicant’s right of access to the Courts to be
defeated by inherent delays in Court procedures. It is pointed out in this
regard that in the case of
Murphy
-v- Greene
the judgment of the Supreme Court was delivered on the 18th December, 1990 in
circumstances where the decision of the High Court appealed from was given on
the 9th May, 1988. There was accordingly a gap of two years and seven months
between the Order of the High Court and the decision of the Supreme Court. It
is further pointed out that the application in that case related to an incident
which had occurred in May of 1985. It is submitted accordingly that the
Supreme Court judgment was given some five years and seven months after the
events giving rise to the application. It is pointed out by Counsel before me
that while dealing with the substantive issue in that case the Supreme Court
made no reference to the possibility that the proposed claim was statute
barred, nor does it appear to have been argued before the Supreme Court that
the claim would be statute barred.
53. In
summary it is submitted that a cause of action does not exist and time does not
begin to run against a potential plaintiff during the period when he is
prohibited by statute from issuing proceedings. The cause of action is
complete, and time begins to run against the potential plaintiff, only when he
is given permission by the High Court (or on Appeal by the Supreme Court) to
issue proceedings.
54. In
the written submissions of Mr. Noonan of Counsel on behalf of the first
Respondent it is stated in response to the submissions made on behalf of the
Applicant in this regard that it is accepted that the issue of the statute does
not appear to have been averted to in the case as cited and the point was not
taken against the Applicant in those proceedings. It is submitted that there
is no reason in fact why an Applicant should not be required to have his
application for leave not only issued but also dealt with within the three year
period. It is submitted that if it was apprehended that the application was
about to become statute barred, obviously an urgent application could be made
to the Court and it is submitted that such an application would certainly not
be without precedent.
55. In
light of the evidence before me which in fact discloses a clear conflict
between the Applicant and the Respondents and in light of the fact that none of
the witnesses who have sworn affidavits on behalf of the Respondents, including
the first Respondent himself, have been cross-examined on their evidence, I am
not satisfied that there are substantial grounds for contending that either of
the Respondents acted in bad faith or without reasonable care.
56. With
regard to the actions of the Health Board I am satisfied that considerable care
was exercised by the officers of the Health Board concerned in dealing with the
Applicant and as soon as they had observed him overnight and were satisfied
that no risk was present, they released him back into the community. It is
clear also that they had a reference at that time from a medical practitioner
which suggested the necessity of having the Applicant committed at that time
and it was necessary for them to examine that situation before reaching any
concluded view in the matter. I am satisfied that the detention for the
assessment in the circumstances was appropriate.
57. With
regard to the first Respondent no case of bad faith arises with regard to his
actions, albeit a question mark has been raised in relation to the motivation
of the Applicant’s brother in making the complaint to the first
Respondent. With regard to the second aspect namely whether the first
Respondent acted without reasonable care it is clear that further inquiries
might have changed the conclusion that was reached at the time. Nevertheless,
I am satisfied that the first Respondent acted in the belief that his
informants were reliable persons and had no reason to believe at that time that
their allegations against the Applicant were false or motivated by any
malicious intent. Furthermore, the first Respondent had a medical history in
relation to the Applicant showing that he had suffered depression some years
prior to the events in question. Thirdly, this Court has the evidence of Dr.
Loftus himself in relation to his observations at the time when he went to
visit the Applicant. In this regard he says that he acted on the basis of his
own clinical assessment and judgment of the Applicant’s condition,
secondly on the basis of credible history of the Applicant’s behaviour in
the recent past which he considered to come from reliable witnesses, and
thirdly, on the basis of the Applicant’s medical and psychiatric history
which was then known to him. He states that he believed that there was a
genuine and immediate risk to the safety and welfare of the applicant and to
the members of his family which required urgent psychiatric assessment and if
necessary treatment. As previously stated the doctor was not cross examined on
his affidavit. Clearly he placed some reliance on what he was told by Mr. Ronan
Lehany. While he may have been misled in this regard he acted in good faith
and acted in reliance upon what Mr. Ronan Lehany had said to him, believing
that Mr. Ronan Lehany was truthful. While subsequent events must cast some
doubt on the veracity of what was said by Mr. Lehany that is not the basis upon
which this court must judge matters. In all the circumstances of this case I
am not satisfied that the Applicant has discharged the relevant onus of proof
such as to enable me to be satisfied that there are substantial grounds for
contending that Dr. Lehany acted in bad faith or without reasonable care.
58. With
regard to the statute of limitations it is to be noted that almost three years
had passed before the papers grounding this application were filed in the High
Court which was on the 3rd June, 1999. I am of the opinion that the relevant
period of limitation is a three year period in the absence of any special
provision pertaining to any claim under the Act of 1945 and in light of the
repeal of Section 259 and Section 260 (4). While there indeed may be some
force in the arguments advance on behalf of the Applicant that an application
brought to the Courts may itself be delayed by the procedures involved in
obtaining leave of the Court, I am satisfied that this matter is not catered
for in the law as it stands and accordingly, if I was satisfied, which I am
not, that the Applicant had discharged the onus of proof upon him under the
provision of Section 260 (1) to show substantial grounds for contending that
the Respondents acted in bad faith or without reasonable care, I would
nevertheless be compelled to conclude that the proposed claim was statute
barred and in those circumstances I would not be disposed to give leave to the
Applicant to institute the within proceedings. In so concluding I must act on
the basis of the presumption of constitutionality attaching to the section in
circumstances where no challenge to same exists in these proceedings.